The rules were created in response to the ever-escalating problem of opioid prescription pain medication abuse, addiction, and diversion. Indeed, opioid pills have become one of the easiest street drugs to obtain and are now the leading type of illicit drug abuse. The new regulations are also meant to tighten up loose prescribing practices, better identify prescribers acting illegally, and ultimately reduce opioid-related deaths.

The medical community is generally supportive of these new regulations and was involved with their development. I am also supportive since I believe these new rules are fairly reasonable unlike proposals promoted in past years. But there may be unintended consequences: Rules are the necessary reality but they may be perceived as overly burdensome and discourage physicians and other providers from prescribing opioids to their legitimate chronic-pain patients.

Understand that the opiate prescribing rule is a transformative change. The new requirements for chart documentation, patient evaluation, drug testing, and monitoring are extensive and time-consuming. Some providers are considering no longer prescribing chronic opioids. Others are non-compliant with the new regulations or are ignoring the rule's details and are at-risk for licensure or criminal actions. Some pharmacies now hesitate filling opioid prescriptions and are actually requiring medical information from the patient's chart before honoring the prescription.

Senate Bill 285 would now make an opioid drug called tramadol a "scheduled" medication in Indiana. Scheduled narcotics are medications that are deemed at high risk for abuse and addiction and are more tightly controlled. We currently use tramadol as a step down medication from other opioid medications with the belief that it is milder in its pain-relief qualities and has less potential for abuse and addiction. Being unscheduled, it is not subject to the prescribing rule.

Does tramadol have abuse, addiction, and diversion potential? Yes. But many believe that these risks are much less than other opioid medications. For years, I performed outpatient opioid detoxification as part of my practice. I never once detoxed a patient from tramadol nor did I have the impression that the addicts commonly sought tramadol.

SB285 is moving through the legislature like a freight train with wide support including backing from the Indiana State Medical Association and the Indiana State Department of Health. We have no adequate choices to treat moderate to severe chronic pain other than opioid medications. Tramadol is the last of these medications prescribers can use without the obligations of the opioid rule. Give providers at least one option.

Are we moving too quickly and aggressively with opioid regulation? Will we produce an era of inadequate pain treatment? I fear that possibility.

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Fear of drug abuse, addiction may hurt pain patients

A primary-care physician recently said to me, 'My partner doesn't know what to do with his chronic pain patients. He doesn't want to prescribe opiates any longer.'